Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 046758 | CT |
Y | 111NI0900X | Internist | 046758 | CT |
N | 207RG0300X | Geriatric Medicine | 046758 | CT |
NPI | 1114968302 |
---|---|
Provider Name | Yvette Fernandez |
First Address | Waterbury, CT 06708-3346 |
Second Address | Waterbury, CT 06708-3346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008004330 | (05) | CT |
010046758CT01 | ANTHEM (01) | CT |
G75850 | (02) | NY |